Safety of Terlipressin for Hepatorenal Syndrome

Terlipressin has affinity with vasopressin 1 and 2 receptors (V receptors), which reflects its pharmacological effects and safety profile. V1 receptor-related side effects occur when vasoconstriction is too intense and they are usually ischemic. V2 receptor-related side effects are mainly hyponatremia and, potentially, hypokalemia. No deaths due to adverse events have been reported so far in randomized clinical trials but withdrawal of terlipressin owing to adverse events was necessary in 4% of patients in the published trials. Mild adverse events occurred in about 30% of the patients. However, the number of side effects may be considerably higher in unselected patients. Before therapy is started absolute and relative contraindications should be assessed. Terlipressin is contraindicated or should be used with extreme caution in patients with severe atherosclerotic cardiovascular disease. On initiation and during therapy, patients should be monitored with ECG, blood pressure, daily electrolytes and clinically for peripheral ischemia. There is no specific antidote to terlipressin and prevention and handling of side effects include careful selection of patients, close surveillance, daily consideration of dose and duration of therapy.